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Objective To assess the impact of detailed clinical and histopathological criteria on gender-dependent cancer-specific survival (CSS) in a large consecutive series of patients following radical cystectomy (RCE) for muscle-invasive bladder cancer (MIBC). Patients and methods Between 1992 and 2007, 388 men and 133 women (25.5%) underwent RCE for MIBC. A prospectively maintained database was analysed retrospectively. Uni- and multivariable Cox-regression analyses calculated the impact of detailed clinical and histopathological criteria on CSS. Median follow-up was 59 months (2–162). Results Among clinical and histopathological parameters, only type of urinary diversion differed between men and women. In univariable analysis, CSS did not differ between genders. In multivariable Cox-regression analysis, advanced pT-stage (HR = 2.12; P  < 0.001), lymphovascular invasion (LVI) (HR = 3.47; P  < 0.001), time interval between diagnosis of MIBC and RCE exceeding 90 days (HR = 2.07; P  < 0.001) and female gender (HR = 1.35; P  = 0.048) were related to reduced CSS. In separate multivariable Cox-models for time period of surgery between 1992 an 1999 (HR = 1.52; P  = 0.050), age ≤55 years (HR = 3.00; P  = 0.022), presence of LVI (HR = 1.45; P  = 0.031) and female gender were associated with independent reduced CSS. Conclusion Established clinical and histopathological parameters do not differ significantly between both genders in the present series. Reduced CSS in women is present in historic cohorts possibly suggesting improvement in management over the last years. In particular, female gender has a significant negative impact on CSS in patients younger of age and with positive LVI status possibly suggesting different clinical phenotypes.

Radical prostatectomy remains the mainstay for the treatment of localized prostate cancer. Long-term follow-up data showed excellent cancer control rates in several prostatectomy series. We report biochemical recurrence (BCR) outcomes after radical retropubic prostatectomy (RRP) in a European single center series of patients treated over a 13-year period. Between 1992 and 06/2005, 4,277 consecutive men underwent a RRP at the University Hospital Hamburg Eppendorf, Germany. Kaplan-Meier probabilities of BCR-free survival were determined for those patients with complete preoperative data, postoperative data, and follow-up information. Uni-and multivariate Cox regression models addressed PSA recurrence, defined as a PSA level > or = 0.1 ng/ml. Overall, BCR-free survival ranged between 84, 70 and 61% for 2, 5, and 8 years, respectively. In univariate and multivariate analyses, except for age and type of nerve-sparing technique, all traditional clinical and pathological variables represented statistically independent predictors of PSA recurrence-free survival (all P < or = 0.001). In organ-confined disease, the 10-year recurrence free survival rate was 80 and 30% in non-organ-confined cancers. Our findings confirm excellent long-term biochemical cancer-control outcomes after RRP. High grade prostate cancer at final pathology and seminal vesicle invasion proved to be the strongest risk factors of BCR after surgery.

PurposeHolmium Laser Enucleation of the Prostate (HoLEP) is widely accepted as standard laser enucleation technique for patients with benign prostate obstruction (BPO). Initially developed as a three-lobe enucleation technique, several modifications have been published. Comparison of the enucleation techniques is lacking. Therefor we aimed to compare outcomes of three enucleation techniques (en-bloc vs. two-lobe vs. three-lobe).Material and methodsWe prospectively collected data of 600 patients treated between 01/2017 and 12/2017 with HoLEP for BPO. Patients were randomised to either enbloc, two-lobe, or three-lobe enucleation, respectively. Data collection consisted of parameters on operation time, perioperative parameters, and functional outcomes. Univariate and multivariate analyses (ANOVA-test for continuous variables; Chi2-test for categorical variables) were performed regarding differences between the three enucleation techniques.ResultsPatient characteristics were not significantly different (all p > 0.05). Significant differences were observed with respect to overall operation time (en-bloc vs. two-lobe vs. three-lobe: 40.5 vs. 40.7 vs. 47.9, respectively; p < 0.001), speed (g/min.) (en-bloc vs. two-lobe vs. three-lobe, 1.82 vs. 1.76 vs. 1.67, respectively; p 0.006), and enucleation time (en-bloc vs. two-lobe vs. three-lobe: 31.7 vs. 32 vs. 37.7, respectively; p < 0.001). When solely comparing en-bloc vs. two-lobe enucleation, differences in terms of enucleation time, operation time, and speed were not significantly different (p 0.8, 0.9, and 0.2, respectively). Postoperative outcomes were not significantly different.ConclusionAll three HoLEP enucleation techniques show similar postoperative outcomes. However, enbloc and two-lobe enucleation are significantly faster with respect to enucleation, overall operation time, and speed compared to the three-lobe technique.

Background A larger number of dissected lymph nodes (LN) during pelvic lymphadenectomy in patients with muscle-invasive transitional-cell carcinoma of the bladder treated by radical cystectomy (RC) is crucial for exact tumor staging and is associated with a positive oncological outcome. Methods Clinical and pathological records of 1291 patients undergoing RC due to LN-negative transitional-cell carcinoma of the bladder were summarized and evaluated in a multi-institutional database. The number of removed LNs and the presence or absence of lymphovascular invasion were assessed. On the basis of multivariate Cox regression analyses, a threshold number of removed LNs was defined that exerted an independent influence on cancer-specific survival (CSS). Results In multivariate Cox regression models for different numbers of removed LNs, a statistically significant enhancement of CSS could be demonstrated for a LN count of 16. Furthermore, the integration of the dichotomized LN count of 16 resulted in a statistically significantly enhanced predictive ability of the model for CSS. Patients with <16 and ≥16 removed LNs showed CSS rates after 5 years of 72% and 83%, respectively ( P  = 0.01). In addition, age, sex, pT stage, and lymphovascular invasion had independent influences on CSS in every Cox regression model. Conclusions In patients undergoing RC, removal of a higher LN count is associated with an improved oncological outcome. The information resulting from an assessment of lymphovascular invasion and an extended lymphadenectomy is critical for stratification of risk groups and identification of patients who might benefit from adjuvant treatment.

Objectives Beyond oncological safety, consideration of 30-day complications according to Clavien–Dindo, as well as postoperative quality of life (QoL) after nephron-sparing surgery for clinical T1 renal masses, represents important factors for treatment decision counseling. The objective of this study was to compare the effect of laparoscopic versus open partial nephrectomy (LPN vs. OPN) on 30-day complications and long-term postoperative QoL for clinical T1 renal masses. Methods Retrospective, longitudinal analysis of 293 patients treated with either LPN versus OPN for T1 renal masses. The investigated endpoints were 30-day Clavien–Dindo complications and health-related QoL (EORTC QLQ-C30). Respectively, logistic and linear regression models analyzed the effect of surgical partial nephrectomy approach on endpoints. Results Overall complication rates were similar in patients undergoing OPN or LPN (16.1 vs. 14.6 %, p  = 0.8). Significantly less major complications (2.4 vs. 10.4 %, p  = 0.025) occurred after LPN. Despite a shorter convalescence period for LPN patients ( p  = 0.035), in uni- and multivariable analyses, surgical approach was not associated with 30-day complications nor long-term differences in QoL (all p  > 0.05). Conclusions Despite a faster recovery time after LPN, our findings suggest that LPN and OPN are equivalent with regard to 30-day Clavien–Dindo complication rates and long-term QoL.

Critical thermodynamics close to a metamagnetic quantum critical endpoint (QCEP) in a metal is discussed within the framework of spin-fluctuation theory. We analyze the effective potential for the Ising order parameter that is renormalized by spin-fluctuations and acquires a characteristic temperature dependence. The resulting magnetic field, H, and temperature, T, dependence of the magnetization, specific heat, thermal expansion, magnetostriction, susceptibility and the Gr\"uneisen parameter are determined, and the crossover lines in the (H,T) phase diagram are specified. We point out that the metamagnetic QCEP is intrinsically unstable with respect to a magnetoelastic coupling.

The critical properties of the finite temperature Mott endpoint are drastically altered by a coupling to crystal elasticity, i.e., whenever it is amenable to pressure tuning. Similar as for critical piezoelectric ferroelectrics, the Ising criticality of the electronic system is preempted by an isostructural instability, and long-range shear forces suppress microscopic fluctuations. As a result, the endpoint is governed by Landau criticality. Its hallmark is thus a breakdown of Hooke's law of elasticity with a non-linear strain-stress relation characterized by a mean-field exponent. Based on a quantitative estimate, we predict critical elasticity to dominate the temperature range DeltaT/Tc ~ 8% close to the Mott endpoint of kappa-(BEDT-TTF)2X.

We discuss elastic instabilities of the atomic crystal lattice at zero temperature. Due to long-range shear forces of the solid, at such transitions the phonon velocities vanish, if at all, only along certain crystallographic directions, and, consequently, the critical phonon fluctuations are suppressed to a lower dimensional manifold and governed by a Gaussian fixed-point. In case of symmetry-breaking elastic transitions, a characteristic critical phonon thermodynamics arises that is found, e.g., to violate Debye's \\(T^3\\)-law for the specific heat. We point out that quantum critical elasticity is triggered whenever a critical soft mode couples linearly to the strain tensor. In particular, this is relevant for the electronic Ising-nematic quantum phase transition in a tetragonal crystal as discussed in the context of certain cuprates, ruthenates and iron-based superconductors.

Elastic phase transitions of crystals and phase transitions whose order parameter couples linearly to elastic degrees of freedom are reviewed with particular focus on instabilities at zero temperature. A characteristic feature of these transitions is the suppression of critical fluctuations by long-range shear forces. As a consequence, at an elastic crystal symmetry-breaking quantum phase transition the phonon velocity vanishes only along certain crystallographic directions giving rise to critical phonon thermodynamics described by a stable Gaussian fixed point. At an isostructural solid-solid quantum critical end point, on the other hand, the complete suppression of critical fluctuations results in true mean-field critical behavior without a diverging correlation length. Whenever an order parameter couples bilinearly to the strain tensor, the critical properties are eventually governed by critical crystal elasticity. This is, for example, the case for quantum critical metamagnetism but also for the classical critical Mott end point at finite \\(T\\). We discuss and compare the solid-solid end points expected close to the Mott transition in V\\(_2\\)O\\(_3\\) and \\(\\kappa\\)-(BEDT-TTF)\\(_2 X\\).

As a paradigmatic example of multi-scale quantum criticality, we consider the Pomeranchuk instability of an isotropic Fermi liquid in two spatial dimensions, d=2. The corresponding Ginzburg-Landau theory for the quadrupolar fluctuations of the Fermi surface consists of two coupled modes, critical at the same point, and characterized by different dynamical exponents: one being ballistic with dynamical exponent z=2 and the other one is Landau-damped with z=3, thus giving rise to multiple dynamical scales. We find that at temperature T=0, the ballistic mode governs the low-energy structure of the theory as it possesses the smaller effective dimension d+z. Its self-interaction leads to logarithmic singularities, which we treat with the help of the renormalization group. At finite temperature, the coexistence of two different dynamical scales gives rise to a modified quantum-to-classical crossover. It extends over a parametrically large regime with intricate interactions of quantum and classical fluctuations leading to a universal T-dependence of the correlation length independent of the interaction amplitude. The multiple scales are also reflected in the phase diagram and in the critical thermodynamics. In particular, we find that the latter cannot be interpreted in terms of only a single dynamical exponent: whereas, e.g., the critical specific heat is determined by the z=3 mode, the critical compressibility is found to be dominated by the z=2 fluctuations.